Risk factors for post-discharge venous thromboembolism in patients undergoing colorectal resection: a NSQIP analysis
Risk factors for post-discharge venous thromboembolism in patients undergoing colorectal resection: a NSQIP analysis
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DOI：
10.1007/s10151-018-1909-8
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发表时间：
2018-12-01
影响因子：
3.3
通讯作者：
Lee, L.
中科院分区：
文献类型：
--
作者：
Alhassan, N.;Trepanier, M.;Lee, L.
建议在腹部和盆腔癌手术后延长血栓预防以预防静脉血栓栓塞事件 (VTE)，但依从性不佳。识别出院后事件风险最高的患者可能有助于选择性延长血栓预防。我们研究的目的是确定院内和出院后发生静脉血栓栓塞的不同危险因素。对美国外科医生学会-国家手术质量改进计划（ACS-NSQIP）2012-2016年数据库中的所有接受结直肠切除术的患者进行了查询。主要结局是术后 30 天内发生 VTE。进行多项 Logistic 回归以确定 VTE 的院内和出院后预测因素，并调整潜在的混杂因素。在 260,258 名患者中，5381 名 (2.1%) 发生了 VTE。共有 3442 人（1.3%）在住院期间和出院后 1929 人（0.8%）被诊断出来。院内和出院后 VTE 的危险因素不同，因为发生院内事件的患者更有可能年龄较大、男性、术前使用类固醇、功能状态差、体重明显减轻、术前败血症、手术时间延长、接受紧急手术。在出院后的情况下，类固醇的使用、功能状态不佳、术前败血症和术后并发症仍然很严重。术后并发症是院内和出院后 VTE 的最强预测因素。无论是住院还是出院后事件，炎症性肠病患者发生 VTE 的风险均高于恶性肿瘤患者。出院后事件高危患者与院内发生 VTE 的患者具有不同的特征。识别出院后 VTE 风险最高的特定患者亚群可能有助于选择性地使用长期血栓预防。
Extended thromboprophylaxis after abdominal and pelvic cancer surgery to prevent venous thromboembolic events (VTE) is recommended but adherence is sub-optimal. Identifying patients at highest risk for post-discharge events may allow for selective extended thromboprophylaxis. The aim of our study was to identify the different risk factors of venous thromboembolism for in-hospital and post-discharge events.The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) 2012-2016 database was queried for all patients having colorectal resection. Primary outcome was postoperative VTE occurrence within 30 days. A multinomial logistic regression was performed to identify in-hospital and post-discharge predictors of VTE, adjusting for potential confounders.Out of 260,258 patients, 5381 (2.1%) developed VTE. A total of 3442 (1.3%) were diagnosed during the initial hospital stay and 1929 (0.8%) post-discharge. Risk factors for in-hospital and post-discharge VTE were different as patients with an in-hospital event were more likely to be older, male, known for preoperative steroid use, have poor functional status, significant weight loss, preoperative sepsis, prolonged operative time, undergoing an emergency operation. In the post-discharge setting, steroid use, poor functional status, preoperative sepsis, and postoperative complications remained significant. Postoperative complications were the strongest predictor of in-hospital and post-discharge VTE. Patients with inflammatory bowel disease had a higher risk of VTE than patients with malignancy for both in-patient and post-discharge events.Patients at high-risk for post-discharge events have different characteristics than those who develop VTE in-hospital. Identifying this specific subset of patients at highest risk for post-discharge VTE may allow for the selective use of prolonged thromboprophylaxis.